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New York Improperly Claimed Federal Medicaid Reimbursement for Partial Hospitalization Services

New York claimed Federal Medicaid reimbursement for partial hospitalization services claims that did not comply with Federal and State requirements. Specifically, of the 100 claims in our random sample, 59 claims complied with Federal and State requirements, but 41 claims did not. The deficiencies occurred because certain providers did not comply with partial hospitalization program requirements. In addition, although New York performed licensing renewal visits to providers at least every 3 years, these visits were not effective in preventing instances of noncompliance during our audit period. On the basis of our sample results, we estimated that New York improperly claimed at least $4 million in Federal Medicaid reimbursement over 5 years for partial hospitalization services that did not meet Federal and State requirements.

Filed under: Centers for Medicare and Medicaid Services